Breast Reconstruction: Benefits vs. Cosmesis
What are breast reconstruction benefits and are the benefits vs. cosmesis equal or separate? Although this question may not have been stated in these words, women considering breast reconstruction must think about this complex question. No one can come close to knowing what this decision involves except the patient themselves. Not only is it a difficult and complex process of logic but it involves a great emotional decision as well. I am speaking about breast reconstruction in very specific circumstances.
Humans are faced with many unexpected events in life that catapult us to become educated about a topic we never imagined we would be learning about. A cancer diagnosis or finding that you are BRCA positive is one of those life events. Those who are considering breast reconstruction after cancer or for prophylactic reasons to greatly decrease chances of a cancer occurrence go through great mental gymnastics to come to a decision to have breast reconstruction. There will be an assault to your body under either circumstance. A cancer diagnosis can very suddenly turn a woman or man with all body parts intact one moment into an amputee within hours after surgery when diseased, cancerous, breasts are removed. A young woman who is BRCA positive, still of child-bearing age, and who chooses a prophylactic mastectomy can suddenly face the loss or ability to nurse a future child when the breast tissue is replaced with an implant or by using other body tissue if flap reconstruction is chosen.
The unintended education of the patient.
You go through the process of becoming educated on the topic first with your medical team. A patient will hopefully work with a compassionate breast surgeon and plastic surgeon through this shared decision making process. If you choose free flap surgery then the selection for a qualified microsurgeon becomes even narrower because of the specialized nature of the profession and the hours of dedication to become skilled at microsurgery. The hope is that with any of these surgical specialties that there is that element of compassion and dedication that endears you to these professionals in way that gives you complete confidence in their skill.
Let me put your mind at ease. There are those micro-surgeons who exist! Take a look at a blog written by one such micro-surgeon, Dr. Karen Horton, that I know through social media. Not only does it reflect her own passion for the profession but her blog shares the vision of those in training to become equally as gifted in the field. My own micro-surgeon that I researched well has a level of emotional intelligence and compassion that immediately put my mind at ease. There are few professions that take a scalpel to a body as a way of life that must be able to establish that connection with their “customer” and in this case, the patient.
When a patient begins to explain to family members and friends the choice to have reconstruction the initial reaction can often times be one of an assumed cosmetic value. I told my own plastic surgeon once that I never in a million years thought I’d be sitting in a plastic surgeon’s office. I had predetermined perceptions about plastic surgery based on non-evidence based articles; articles I read about celebrities. Then my own life event of a second recurrence of cancer forced me to learn about plastic surgery and the sub-specialty of microsurgery.
The True Gain of The Cosmetic Value
I’ll be honest with you. When I had my mammogram and found out from my radiologist that the suspected image detected was likely cancer; my thoughts immediately went to double mastectomy. I knew enough at that point that a second occurrence was likely going to result in that outcome. What I didn’t think about was reconstruction. Fortunately for me, I was told immediately, the very day of the confirmed diagnosis, about DIEP flap surgery. Thinking back retrospectively on that day, I was fascinated and had a sense of hope, relief, that I could actually have a lost body part restored. Did I consider it cosmetic at the time? I suppose as a woman, a wife, and one who believes that femininity is a gift, a womanly quality to be valued and nurtured, yes; I thought of it as a cosmetic benefit. What I didn’t truly appreciate at the time was the true gain of the cosmetic value.
Dealing with the Repercussions of the Diagnosis
The confidence that is stripped away after losing the very thing that defines you as a woman was something unexpected. Before my mastectomy, I wanted the cancer gone. Get rid of the disease and deal with the repercussions later. After the mastectomy, I began dealing with the loss of my breasts, mourning the loss of those body parts and truly understanding the cosmesis of the microsurgery. I began researching micro-surgeons to perform my DIEP flap surgery and looked in amazement at the before and after photos. Is it possible that my feminine shape and figure could be restored in a manner that was reflected in the photos? This research was all taking place during a time that I was frequently declining social engagements because I was uncomfortable wearing breasts prosthesis. I did not feel feminine in my clothing. Declining social engagements was not in my nature. I am the type of individual who is generally energized by interacting with people. This personal change in and of itself was difficult for me to deal with. Was I becoming an unintended recluse now that I was finally dealing with those repercussions? This process of mourning and loss was all part of the education of the cancer patient. The mastectomy event in life catapulted me into a new realm of learning that I never imagined I would have to deal with.
Speaking to others about your decision to have reconstruction and that you will be going to a plastic surgeon does conjure up some of those same preconceived notions I had myself about plastic surgery. Some family members and friends I spoke to understandably went straight to the cosmetic reasons to reconstruct. It is in the education that we help both ourselves and others understand the added value in cosmesis of breast reconstruction. Let me put it in very tangible terms.
Most individuals desire to be contributors and to have a purposeful life, whether it is through a volunteer position or one that is monetary in nature. I have spoken to many women through my education and outreach about breast reconstruction that say over and over again, “I’m so happy I can get back to my life.” There are those, like myself, who have found a new purpose in life through their reconstruction. Either way, it is gaining back an individual and their ability to contribute to family, community, an organization, or a profession in a way that brings value to their own life and to others. So make no mistake, the cosmesis of plastic surgery in breast reconstruction is of value.
No less important are the actual benefits of the surgery. So the question begs; is the cosmesis a benefit? Indeed it is but how do you separate benefit from cosmesis? I suppose that might be an individual opinion regarding how you do separate the two. But I am the breast reconstruction patient. I am the one who was unintentionally educated and can speak with true authority of both the cosmesis as well as the benefits.
I did not know that after losing my breasts I would literally feel out of balance. I spoke to my breast surgeon about this at a follow up appointment after my mastectomy. I told her I felt clumsy, out of balance. She explained to me that many women feel this way after surgery and the loss of their breasts. This is something I never really considered before surgery. Let’s look at the first benefit of breast reconstruction: physically feeling back in balance. It is hard for the general public to understand this when you are a “hidden amputee”. I am not comparing apples to oranges here. There is no comparison. But we frequently look at the visible loss of a limb of an amputee and think to ourselves that it took surgery and physical therapy to regain balance and getting used to the loss of their body part. Only a mastectomy patient would truly understand what I’m speaking of when I talk about the loss of symmetry and what it does to your sense of physical balance.
Women choose to have reconstruction under many circumstances. My own reconstruction was delayed seven months after my mastectomy. Additionally, because I had radiation to my left breast for the first occurrence of breast cancer 12 years previous to my reconstruction, I had skin that was compromised by radiation. Dr. Gary Arishta of PRMA plastic surgery explains it well.
Radiation also has deleterious effects on normal breast tissue as well. The radiation causes permanent changes to the normal breast tissue. It causes fibrosis of the tissues and decrease in elasticity. The breast feels tighter and the skin and underlying tissues are less stretchy. The micro-vascular circulation is damaged and blood flow is reduced. These effects are present in the breast and skin forever. The changes can be more pronounced in some patients, but all treated tissues are affected. ~ Dr. Gary Arishta, PRMA Plastic Surgery
The benefits of breast reconstruction using a woman’s own tissue are explained further by Dr. Arishta in this blog. Many women I have spoken to say how pleased they are to regain the range of motion that was lost due to radiation after cancer. I also speak to women who have had implants or tissue expanders replaced by their own tissue using various flap surgeries. The new breasts are warm, they are soft and they are truly a part of you. The fact that blood vessels are disconnected from one part of the body and reconnected to the breast area lost to disease again, is a feeling that only the patient can truly appreciate the benefit of. You feel “hug-gable” again. You don’t have any foreign objects in your body.
Odd as it may sound, a day still does not go by that I don’t look at and touch my warm, soft reconstructed breasts and feel so very thankful that I had this choice and option to enjoy the benefits and advancements in plastic surgery that was not available to others years previous to microsurgery in breast reconstruction. You simply cannot understand or feel the true benefit unless you have had this procedure performed on your own body.
The benefits, I’m sure, are varied and far more detailed and intricate that what I have outlined here. Which is more valuable, the cosmesis or the benefits? It may seem a bit like asking, “Which came first; the chicken or the egg?” Are they one in the same or truly independent of each other? My reconstruction surgeon summed it up quite nicely, “The benefits of breast reconstruction extend beyond the cosmesis.” The two become intertwined in the careful balance and subsequent results of microsurgery for the patient.
An Era of Unprecedented Passion and Evidence Based Research
We are living in an era of unprecedented passion to challenge the science and evidence based research about what can be done to use our own body’s mechanisms to restore them to a balanced state after the loss of a limb or body part due to amputation from trauma or disease.
Let us encourage education and outreach on these amazing topics so that judgment and assumptions are not made about a patient’s decisions or physician’s statements regarding the benefits of these procedures. The physician becomes the instrument that can determine the true benefit, cosmesis or otherwise, for the patient. I consider it a privileged to inform and educate others about breast reconstruction. My hope is you are patient, open-minded and not judgmental about why anyone compassionately chooses to reconstruct breasts for a profession or chooses to have the procedure done to rebuild their life.
It is in truly listening that we are educated and it is in making informed decisions that we are truly empowered in our choice to have breast reconstruction.